Information Collection

Duplicate Salt Sample Collection

IC 207196 under ICR 201401-0920-004 · OMB 0920-0982.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Duplicate Salt Sample Collection	Form
Bag Label Salt Added at the Table Att 13A1_Bag Label Salt Added at the Table_01082014.doc	Form
Bag Label Salt Added in Food Prep Att 14A1_Bag Label Salt Added in Food Preparation_01082014.doc	Form
Att 13B_Dup Salt Sample Instr (Non Sub Study)_01082014.doc Att 13B_Dup Salt Sample Instr (Non Sub Study)_01082014	IC Document
Att 13C_Dup Salt Sample Collection Instr (non Sub Study)_01082014.docx Att 13C_Dup Salt Sample Collection Instr (non Sub Study)_01082014	IC Document
Att 14B_Dup Salt Sample Collection Instr (Sub Study)_01082014.doc Att 14B_Dup Salt Sample Collection Instr (Sub Study)_01082014	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Bag Label Salt Added at the Table	Att 13A1_Bag Label Salt Added at the Table_01082014.doc		No	No	Paper Only
Form	none	Bag Label Salt Added in Food Prep	Att 14A1_Bag Label Salt Added in Food Preparation_01082014.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 252

Number of Respondents: 225

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 13B_Dup Salt Sample Instr (Non Sub Study)_01082014	Att 13B_Dup Salt Sample Instr (Non Sub Study)_01082014.doc	01/09/2014
Att 13C_Dup Salt Sample Collection Instr (non Sub Study)_01082014	Att 13C_Dup Salt Sample Collection Instr (non Sub Study)_01082014.docx	01/09/2014
Att 14B_Dup Salt Sample Collection Instr (Sub Study)_01082014	Att 14B_Dup Salt Sample Collection Instr (Sub Study)_01082014.doc	01/09/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.